Healthcare Provider Details

I. General information

NPI: 1184875551
Provider Name (Legal Business Name): JODI LYNN SERSCH MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BLUE JAY WAY
CAMBRIDGE WI
53523-9547
US

IV. Provider business mailing address

4252 N POLARIS PKWY
JANESVILLE WI
53546-9327
US

V. Phone/Fax

Practice location:
  • Phone: 608-423-4345
  • Fax:
Mailing address:
  • Phone: 608-921-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2771-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: